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Providers are reminded that endometrial ablation, with or without
hysteroscopic guidance, is covered for premenopausal women with menorrhagia
(excessive menstrual flow) and a benign endometrium who are unresponsive to, or
have a contraindication to, hormone therapy and would otherwise be considered
candidates for hysterectomy.
Endometrial ablation is a procedure used to treat menorrhagia in
premenopausal women who have completed childbearing. During the procedure, an
energy source is used to ablate (destroy) endometrial tissue to reduce
menstrual flow. It is an alternative to hysterectomy that is used when other
treatments, such as hormone therapy, have either failed to reduce menstrual
flow or cannot be taken.
Endometrial ablation is contraindicated in individuals who have:
- confirmed pregnancy or desire for a future pregnancy;
- history of endometrial cancer or precancerous histology;
- active infection (genital or urinary tract) at the time of the procedure;
- active pelvic inflammatory disease;
- intrauterine device (IUD) in place at the time of the procedure;
- any anatomic or pathologic condition (e.g., history of previous classical
caesarean sections or transmural myomectomy) in which weakness of the
myometrium could exist.
For more information, please visit our
Medical Policy Portal. Select
Accept and Go to Medical
Policy Online, and then select the
Commercial or
Medicare
Advantage tab from the top of the page, depending on the version of the
policy you'd like to view. Then type the policy name or number in the Search
field:
- Commercial: #11.06.05c: Endometrial Ablation
- Medicare Advantage: #MA11.065a: Endometrial Ablation
You can also get to our Medical Policy Portal through the
NaviNet
® web portal by selecting the
Reference Tools
transaction, then
Medical Policy.
NaviNet is a registered trademark of NaviNet, Inc., an
independent company.
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